Lami, M

Malabanan, KA

McAuliffe, OL

Medical Education Online

PubMed

Spiral - Imperial College Digital Repository

LETTER TO THE EDITORTeledermatology in medical education  a ‘rash’ decision?The benefits of ‘teledermatology’ have been widelydocumented; most importantly, teledermatology hasreduced referral times for patients saving moneyfor the burdened NHS (1). However, with less need forface-to-face consultations (2), there may be fewer oppor-tunities for medical students to get hands-on experiencewith dermatological conditions. While access to patientimages will help enhance students’ diagnostic abilities (3),may they be losing out on acquiring vital clinical skills,such as the art of building patient rapport? In this article,we intend to discuss the impacts of teledermatology, noton current or future patients, but on the students trainingto help them.As a highly visual specialty, students will undoubtedlybenefit from having access to a large store of dermatolo-gical images. Not only will students have exposure to whatis common, they will also have the chance to see how rarerconditions present; this is an opportunity they may nothave when practicing in a general dermatology clinic. Easyaccess to a wide variety of presentations of skin diseasewill also train the eye for spot diagnoses in a much quickerperiod of time. In one study comparing the eye move-ments of consultant dermatologists to registrars, consul-tants made quicker diagnoses. This is because consultantshave more experience and therefore more advanced skillsin eye pattern recognition (4). Therein lies the rub  thereis ongoing uncertainty surrounding the use of patientimages for educational purposes. Legalities regardingmedical student access to the images needs to be finalized.As previously alluded to, teledermatology creates doctorswith a better base of knowledge. In the only publishedpaper to have evaluated medical students’ perspectiveon teledermatology, 88% agreed that it is beneficial forbuilding knowledge and practice-based learning (3). How-ever, communication skills and professionalism were feltto be neglected. Even with real-time videoconferencing,which has also been introduced to dermatological practice,communication with patients is limited and student learn-ing can be minimal. An endless photo bank may createa doctor who can diagnose but not necessarily one whocan empathize when dealing with the many associatedpsychosocial aspects within dermatology. William Osleronce said ‘The good physician treats the disease; the greatphysician treats the patient who has the disease’. Could theintegration of this tool lead students to become lazy intaking a holistic view of the patient?Moreover, teledermatology may affect student skillsets.There have been issues with ‘zoning’ when using tele-dermatology to diagnose patients, where more focus isplaced on the main lesion while everything else remainsin the periphery (5). Our generic history taking en-courages us to build up an overall picture of factors thatcould affect patient health from family history to smok-ing. Another issue is the lack of physical contact withskin lesions. Often, examination with touch plays a keyrole in diagnosis and yet it is disregarded in this methodwhich favors the use of two-dimensional images. Bothzoning and lack of touch may compromise studentclinical skills.Because of a decreased need for consultations and areduced workload for consultants and specialists, perhapsthere will be more time for the holistic care of patients andfor teaching and sharing of dermatological knowledge.From experience, we have spent time shadowing consul-tants with little opportunity to practice being doctors.The snowball effect of improved dermatological teachingmay reach into primary and secondary care. However,could teledermatology trivialize dermatology in second-ary care and create a loss of interest in the specialty?If so, we can expect a dramatic decline in job opportu-nities, with fewer specialists available to pass on theirknowledge to the future generations. That being said,residents in Newark, USA who had no formal dermato-logical teaching, managed to improve their quiz scoresthrough watching videostreamed lectures from HarvardUniversity. (6). There is no longer an issue of space andtime in sharing knowledge, thanks to online lectures beingstreamed worldwide.Undeniably, teledermatology may benefit medical stu-dents with increased revision resources. But with fewerclinics to practice clinical skills and fewer dermatologiststo pass on their knowledge, student education may relysolely on face-less two-dimensional images rather thanreal-life people. Further studies are needed to evaluate theimpact of teledermatology on medical education. Is theuse of teledermatology a ‘rash’ decision for our currentand future students? Only time will tell.Mariam LamiFaculty of MedicineImperial College LondonLondon, UKMedical Education OnlineMedical Education Online 2015. # 2015 Mariam Lami et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format and toremix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.1Citation: Med Educ Online 2015, 20: 30576 - http://dx.doi.org/10.3402/meo.v20.30576(page number not for citation purpose)Katherine MalabananFaculty of MedicineImperial College LondonLondon, UKOrlaith McAuliffeFaculty of MedicineImperial College LondonLondon, UKEmail: om511@ic.ac.ukReferences1. WHO (2010). Telemedicine- opportunities and developments inMember States. [cited 30 November 2015] Available from: http://www.who.int/goe/publications/goe_telemedicine_2010.pdf2. Loane M, Bloomer S, Corbett R, Eedy D, Hicks N, Lotery H,et al. A randomized controlled trial to assess the clinicaleffectiveness of both realtime and store-and-forward telederma-tology compared with conventional care. J Telemed Telecare2000; 6(Suppl 1): 13.3. Boyers LN, Schultz A, Baceviciene R, Blaney S, Marvi N,Dellavalle RP, et al. Teledermatology as an educational tool forteaching dermatology to residents and medical students. Telemede-Health 2015; 21: 31214.4. Dreiseitl S, Pivec M, Binder M. Differences in examination char-acteristics of pigmented skin lesions: results of an eye trackingstudy. Artif Intell Med 2012; 54: 2015.5. Chen K, Lim A, Shumack S. Teledermatology: influence ofzoning and education on a clinician’s ability to observe peripherallesions. Aust J Dermatol 2002; 43: 1714.6. Williams CM, Kedar I, Smith L, Brandling-Bennett HA, LugnN, Kvedar JC. Teledermatology education for internal medicineresidents. J Am Acad Dermatol 2005; 52: 10989.Mariam Lami et al.2(page number not for citation purpose)Citation: Med Educ Online 2015, 20: 30576 - http://dx.doi.org/10.3402/meo.v20.30576

Teledermatology in medical education -- a 'rash' decision?

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